MEDICARE: RUONALA DURABLE MEDICAL EQUIPMENT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	26556076	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225088974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUONALA DURABLE MEDICAL EQUIPMENT INC.

Provider Business Mailing Address
First Line	:	423 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3023
Country	:	US
Telephone Number	:	843-249-2722
Fax Number	:	843-249-7522

Provider Business Practice Location Address
First Line	:	423 MAIN ST
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3023
Country	:	US
Telephone Number	:	843-249-2722
Fax Number	:	843-249-7522

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VALERIE LYNN RUONALA
Credential	:
Telephone Number	:	843-249-2722

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/10/2007

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